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Organization

WISCONSIN DENTAL GROUP, S.C.

Active
Parent organization
WISCONSIN DENTAL GROUP, S.C.
Other names
ForwardDental Mukwonago
Organization subpart
Yes

Provider details

NPI number
Legal business name
WISCONSIN DENTAL GROUP, S.C.
Authorized official
CELIA HAYES (CREDENTIALING COORDINATOR)
(217) 540-2100
Entity
Organization

Contact information

Practice address
214 S ROCHESTER ST, MUKWONAGO, WI 53149-1612
(414) 209-0337
(414) 209-0343
Mailing address
214 S ROCHESTER ST, MUKWONAGO, WI 53149-1612
(414) 209-0337
(414) 209-0343

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary

Other

Enumeration date
03/14/2022
Last updated
04/15/2022
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